Provider Demographics
NPI:1912268756
Name:PUFONG, MARTHA
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:PUFONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:PEGHEBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7826 EASTERN AVE NW
Mailing Address - Street 2:LL18A
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-1324
Mailing Address - Country:US
Mailing Address - Phone:202-722-7776
Mailing Address - Fax:202-722-7785
Practice Address - Street 1:7826 EASTERN AVE NW
Practice Address - Street 2:LL18A
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-1324
Practice Address - Country:US
Practice Address - Phone:202-722-7776
Practice Address - Fax:202-722-7785
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No374U00000XNursing Service Related ProvidersHome Health Aide